MEDICARE: KRISTINA STEVENS LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	39002504A	IN

General Provider Information

NPI Number	:	1861245177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA STEVENS LMHC

Provider Business Mailing Address
First Line	:	6451 COTTON BAY DR N
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4532
Country	:	US
Telephone Number	:	765-993-0824
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 W 71ST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1784
Country	:	US
Telephone Number	:	317-423-1680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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